Gynae Flashcards
Vaginal discharge “fishy smell”
Bacterial Vaginosis
Retained tampon
Trichomonas
Extra Mx for STI? (sex)
SEX
Screen for other STIs
Education - e.g. condom use
Explain about partner education
When not to take COCP?
Migraine w/ aura VTE risk Fat - BMI>35 Smoke Breast cancer - current/carrier of gene Breastfeeding <6weeks postpartum
Secondary ammenorhoea? (use to think about causes of anovulation aswell!)
4Ps Prolactinoma PCOS Pregnant Premature ovarian insufficiency
(others: stress, weight change, anorexia, Kallman’s)
Primary = failure by age of 16 Secondary = none for 6months in woman who previously could/12 months who had irregular
PCOS criteria (i.e. signs and symptoms). Hint - where did Villa win the european cup??
ROTTERDAM criteria -2outof3 required
SHOP string of pearls - on USS hyperandrogenism - acne+hirsutism Oligomenorrhea - irregular + heavy Prolactin normal (also insulin resistance + obesity + subfertility)
[N.B you get high baseline LH + low FSH]
- reduced oestrogen (due to FSH)
- anovulation (high baseline = no LH surge)
PCOS ix?
T4, TSH, Prolactin Serum total + free testosterone Fasting glucose 17-hydroxyprogesterone - for CAH LH/FSH - LH:FSH ratio high - 3:1 USS - string of pearls
PCOS Mx?
1 - Lose weight, stop smoking
1 - CLOMIFENE / IVF (if want to be fertile)
2 - COC / Progesterone
3 - Metformin - ?insulin resistance/weightloss
4 - “Dianette” - acne+hirsutism
5 - Eflornithine cream/ laser/wax/shave - hirsutism
Endometriosis Ix + Mx?
Laparoscopy + Biopsy! - Chocolate cysts (ovaries) + fibroids/adhesions
Mx: - NOT IS ASYMPTOMATIC
Analgesia - para/nsaids
Meds - Stop ovulation - GnRH analogues / COCP/IUS..etc.
Surgery - ablation / excision
General Gynae Ix?
Testosterone - free + total serum Oestrogen TSH, T4 Prolactin LH / FSH USS PREGNANCY TEST
Subfertility definition? Primary/secondary?
Failure to conceive after 12months regular unprotected sex
Primary - female never conceived
Secondary - female conceived previously
Need 3 things - ovulation, healthy sperm, tubal patency
Sperm abnormlatities?
Azoospermia - no sperm
Oligospermia - little sperm
Teratozoospermia - abnormal
Asthenospermia - immotile
Assesment of subfertility - THINK THE 3 DOMAINS!!
Tubal patency - laparoscopy+cye / hysterosalpingogram
Sperm - count, motility, normal forms
Ovulation (i.e. axis!) -
- Prolactin
- FSH/LH
- Oestrogen
- Testosterone
- Progesterone Day21 - confirms ovulation
Mx subfertility? THINK 3 DOMAINS!!
Weight loss, smoking, 2-3 times per week!
Anovulation
- Clomifene / GnRH analogue
- IVF, egg donation
Sperm
- IUI (intrauterine insemination) - speed it up
- IVF
- ICSI (intracytoplasmic sperm injection) - single sperm
Tubal patency
- tubal surgery
- IVF
Miscarriage Mx (once stable)?
Wait + see
Misoprostol
ERPC
GIVE ANTI-D!!!!
Risk factors for Ectopic? (kate middleton’s sister)
Triad of symps - Pain, bleed, amenorrhoea!
PIPPA Previous ectopic IUD - (if got pregnant with it in) Pelvic/tubal surgery PID Assisted reproduction
Ectopic Ix? Mx?
TVUSS
hCG - suboptimal rise + fall between 0+48hrs
Examination - cervical motion tenderness
(FBC, group+save)
Methotrexate
surgical - Laparoscopy + Salpingectomy
Heavy menstrual bleeding causes? Often 1st line Ix?
Dysfunctional uterine bleeding
Fibroids / Polyps
Adenomyosis
(PID, cancer, copper coil, IUS, hypothyroid, coagulopathy)
FBC!! –> then TVUS +/- hysteroscopy (+biopsy)
Heavy menstrual bleeding managment?
Non-hormonal (fertility sparing) - tranexamic acid - anti-fibrinolytic - NSAIDs Hormonal - e.g. IUS, COC - Oral progestogens in luteal phase (e.g. norethisterone)
Surgical:
- myomectomy (fibroids) - fertility sparing
- endometrial ablation, uterine artery embolization, hysterectomy
3 mirena coil indications?
Contraception
Primary menorrhoea
Endometrial protection during HRT
What are the triple swabs?
Endocervical - chlamydia
Endocervical - gonorrohoea
High vaginal - candida, trichomiasis, vaginosis
Ovarian cancer RFs. General rule?
What protective?
Anything that ^number of ovulations
FH BRCA (1>2) Smoking ^Age HRT
COCP + pregnancy = protective!
Endometrial cancer RFs? General path?
Endometrial hyperplasia due to: Annovulation: -PCOS -Premature ovarian insufficiency -prolactin^
Unopposed oestrogen: Age Obesity - adipocytes = stimulus to produce oestrogen oestrogen only HRT COCP Tamoxifen
Common types of HPV + associations? (nursery rhyme)
1 and 2, do up my shoe (veruccas)
11 and 6, warts on pricks (genital warts)
Please beware sweet little 16
Like number 18, she’s an oncogene (Cervical cancer)
Mx for Cervical cancer? obvs classic surgery/chemo/radio - but specific surgeries - a bit different here.
Management of CIN?
Excision - v early stage - LLETZ / cone biopsy
Radical hysterectomy
Trachelectomy - removal of cervix + pelvic nodes w/ preservation of uterus body –> FERTILITY
CIN:
- excision/destruction @ COLPOSCOPY
- LLETZ
- Cone biopsy
- cryo/laser/cold coagulation
Emergency contraception - 3 types. What are they - when can they be given, how do they work?
Levonorgestrel: - progesterone
- delays LH surge - delays ovulation
- within 72hours
Ulipristol: - progesterone receptor blocker
- delays LH surge - delays ovulation
- within 120hours
IUD: - MOST EFFECTIVE
- prevents implantation + toxic to sperm
- within 5 days
Windows of starting contraception + protection
COCP - 7 days
POP - 2 days
IUD - immediate
IUS - 7days
Missed pill rules. COCP? POP?
COCP
Missed 1 - take next one as planned - EC not needed
Missed 2+ - use condoms for 7 days plus:
-Week1 - EC (think as just come off pill free days)
-Week2 - No EC
-Week3- No EC, but miss pill free days
POP
Take missed pill - even if 2 in one day
Barrier methods for 48hours
Bartholin cyst Bugs + Mx?
Anaerobes+Aerobes:
E.coli, staph, strep, proteus
Broad spec - metronidazole / cephalosporin
Incision + drainage –> then marsupialisation
Chlamydia
Bug RF Symps Ix Mx
Gram -ve - chlamydia trachomatis (elementary + reticulate bodies)
Promiscuity + lack of protection
Dysuria, discharge, fever, post-coital bleeding, urethritis (males)
Vulvovaginal swab / endocervical swab
NAAT
first catch urine
Doxy + arithromicin
Gonorrhoea
Bug RF Symps Ix Mx
Gram -ve diplococci - N.Gonorrhoea
promiscuity + lack of protection
Males - dysuria, discharge, perianal pain/bleeding
females - asymptomatic
Vuvlovaginal / endocervical swab
NAAT
First catch urine
IM ceftriaxone + oral azithromicin
Syphillis
Bug RF Symps Ix Mx
V contagious - treponema pallidum
promiscuity + lack of protection
Papules + ulcers at site
latent period >2years - late CV + neuro signs
Treponema enzyme immunoassay (IgM - early infection)
BenPen
PID
Bug RF Symps Ix Mx
Polymicrobial Gram-ve - Chlamydia, gonorrhoea, staph, strep, e.coli
promiscuity + lack of protection
Deep dyspareunia, discharge, fever, vaginal bleeding, abdo pain
Preg test cervical swab + triple swabs USS ESR/CRP urinalysis endometrial biopsy
Doxycylcine + metronidazole + ceftriaxone
Candidiasis
Bug RF Symps Ix Mx
Fungal yeast infection - candida albicans
Common
WHITE COTTAGE CHEESE DISCHARGE
dyspareunia, dysuria
vulval pruritis / soreness
Clinical, high vaginal swab
Antifungal - fluconazole, clotrimazole
Creams/soaps/emollients
Bacterial vaginosis
Bug RF Symps Ix Mx
Lactobacilli REPLACED - by overgrowth of bacteria
promiscuity + lack of protection
DOUCHING + BATHS
FISHY FOUL SMELL
white/grey discharge + dysuria
High vaginal swab
microscopy - CLUE CELLS
pH test (high pH) - +ve Whiff test
Metronidazole + clindamycin cream
Trichomoniasis vaginalis
Bug RF Symps Ix Mx
FLAGELLATED PROTOZOA - trichoman vaginallis
promiscuity + lack of protection
BATHS + DOUCHING
FROTHY YELLOW / GREEN DISCHARGE
STRAWBERRY CERVIX
FOUL SMELLING
dysuria, itching
NAAT
High vaginal swab
Metronidazole
